The Henry Ford Health System's hospitals and its health plan operate in the racially and ethnically diverse area of metro Detroit. But until about seven years ago, the board members of the system and its subsidiaries were largely white, despite leadership's desire to boost diversity.

In 2007, the Detroit-based system launched what is now a routine review of how closely the makeup of its boards reflects the communities it serves. Two years later, it established CEO compensation incentives tied to increased diversity in recruiting and hiring throughout the organization. Only 10 percent of the 900 hospitals and health systems surveyed by the Institute for Diversity in Health Management in 2011 tied executive pay to diversity goals.

Now, Henry Ford's system-level board meets annually with the chairs and nominating committee members for each subsidiary board to review how closely membership reflects community diversity and how recruiting may address gaps.

Sandra Pierce

"We were really very intentional," said Sandra Pierce, board chairwoman for the Henry Ford Health System and president and CEO of FirstMerit Bank.

As a result, across all of its boards, roughly 27 percent of Henry Ford's trustees now are nonwhite, compared with 19 percent in 2005. The share of female board members has remained fairly steady at a little more than one-third.

But at many other nonprofit hospitals and health systems, not much has changed, governance experts say. Last year, 47 percent of nonprofit hospital governing boards lacked even a single racial or ethnic minority member, according to the Governance Institute, a consulting group. While only 3 percent of boards lack female members, the median board makeup is three women among 13 board members.

Two of the most recent American Hospital Association triennial governance surveys found that minority board members accounted for 9 percent of hospital directors and trustees in 2009 and 10 percent in 2011. The latest survey is currently underway.

Boards "in no way" reflect their communities, said Dr. John Combes, president of the AHA's Center for Healthcare Governance.

Over the next three decades, the U.S. will become a "nation of minorities," with no one racial or ethnic group making up a majority of the population, federal projections show. Minorities accounted for 37 percent of the U.S. population in 2012, and that will increase to 57 percent by 2060.

As the nation becomes more diverse, hospitals' lack of diverse leadership grows more troubling, Schlichting said. "It's like we're not paying attention to the world we live in," she said.

"If you never have a metric, then you're never held accountable," said Connie Curran, founder and CEO of Best on Board, a national health care board education and certification company. Explicit financial incentives for executives to expand diversity also help.

"No. 1, you get what you measure," Curran said. "No. 2, you get what you reward."

The issue is about far more than just numbers. Homogeneous boards that fail to reflect the demographics of the communities they serve — by gender, race, ethnicity, age, geography and socioeconomic status — risk excluding knowledge and experience that will better inform policies to improve patient care and provide services communities need, experts say.

Increased diversity in governance and management is one of three strategies critical to eliminating health care disparities, according to a 2012 report issued by the AHA, the Association of American Medical Colleges, the American College of Healthcare Executives, the Catholic Health Association and America's Essential Hospitals.

"The whole point of diversity is diversity of perspectives that will allow a richer mix of viewpoints and sometimes differing views to enhance the quality of deliberations and quality of decisions," said Lawrence Prybil, a professor of health care leadership and associate dean at the University of Kentucky College of Public Health.

One reason for the sluggish progress on diversity nationally is slow turnover among board members, Combes said. Trustees and directors hold longer tenures than hospital CEOs — an average of nine years, compared with four years for CEOs.

More importantly, boards too often do not identify diversity as a major goal, unlike targets for financial performance and quality of care. In 2011, two out of three hospitals surveyed by the Institute for Diversity in Health Management and the Health Research and Educational Trust had no formal goal for their boards to reflect the diversity of their patients.

Experts say boards should incorporate diversity goals into the annual self-assessment, bylaws and committee charters and tools used for trustee and director recruitment. The Center for Healthcare Governance encourages hospitals to include diversity of race, ethnicity, gender, profession and age in board member selection criteria.

Schlichting said she worked to expand her own professional network by meeting with a broader group of diverse board candidates.

"I did a lot of lunches," she said. It's a little like rolling a boulder downhill. As Henry Ford's boards become more diverse, the recruiting network grows broader and more diverse.

"There are always talented people," she said.

Still, limited board diversity across the country won't change as long as board members remain comfortable with a largely homogenous membership and they don't establish clear diversity targets, Best on Board's Curran said.

So far, pressure for change from leadership has been lacking. "Mostly, I think that ignorance is bliss," she said.